Serum transactive response DNA binding protein 43 associates with poor short-term neurologic outcome after return of spontaneous circulation following cardiac arrest.

Abstract

To explore the association of serum transactive response DNA binding protein 43 (TDP-43) with 28-day poor neurologic outcome in patients with return of spontaneous circulation (ROSC) after cardiac arrest. We performed a study between January and December, 2023. Eligible patients with ROSC following cardiac arrest were enrolled. Their baseline characteristics were collected and serum levels of TDP-43, tumor necrosis factor-α, interleukin-6 and -10, C-reactive protein, and neuron-specific enolase (NSE) at 24 h after ROSC were measured. The neurological function was assessed by the cerebral performance category scores on day 28 after ROSC. A total of 92 patients were included, with 51 and 41 patients in the good and poor neurological outcome groups, respectively. Serum TDP-43 was significantly higher in the poor than the good neurologic outcome group (P < 0.05). Univariate and multivariate logistic regression analyses showed that TDP-43, Witnessed CA, IL-6, and NSE were associated with poor 28-day neurologic outcome (all P < 0.05). Restricted cubic spline analysis revealed that TDP-43 at the serum level of 11.64 pg/mL might be an ideal cutoff value for distinguishing between good and poor neurologic outcomes. Area Under Curve of serum TDP-43 (AUC = 0.78) was close to that of serum NSE (AUC = 0.82). A dynamic nomogram prediction model that combined TDP-43, Witnessed CA, IL-6, and NSE was constructed and validated. Elevated serum TDP-43 level was associated with and could be used together with Witnessed CA, IL-6, and NSE to predict poor 28-day neurologic outcome in patients after ROSC following cardiac arrest.